Healthcare Provider Details

I. General information

NPI: 1053618884
Provider Name (Legal Business Name): WILLIAM DOUGLAS MILLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 E 15TH ST
EDMOND OK
73013-8668
US

IV. Provider business mailing address

6412 E 15TH ST
EDMOND OK
73013-8668
US

V. Phone/Fax

Practice location:
  • Phone: 405-343-9432
  • Fax:
Mailing address:
  • Phone: 405-343-9432
  • Fax: 405-954-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number11811
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: